Desikan Kamalakannan

Anticoagulation in Infective Endocarditis: A Survey of Infectious Disease Specialists and Cardiologists

Abstract: Despite several advances in the understanding and treatment of infective endocarditis, there still remain controversy and lack of firm recommendations for the use of anticoagulation therapy in some clinical settings. We surveyed cardiology and infectious disease specialists to determine what expert opinions prevail regarding anticoagulation in infective endocarditis. A questionnaire was mailed to 4000 randomly selected cardiologists and infectious disease specialists across the country. The questionnaire contained 2 scenarios: (1) patients with prosthetic valve endocarditis and (2) patients with native valve endocarditis with another compelling indication for anticoagulation. Different choices for continuing or discontinuing anticoagulation were given, and the responses were analyzed. The results of our survey indicate that majority of the cardiology and infectious disease specialists favor anticoagulation in patients with infective endocarditis in these settings.

Postpartum ovarian vein thrombosis presenting as ureteral obstruction

Ovarian vein thrombosis (OVT) is a relatively uncommon but serious postpartum complication. Although infrequent, OVT may progress to involve the inferior vena cava, the renal vein or may cause sepsis and septic pulmonary embolism, all of which are potentially life-threatening. Clinical misdiagnosis is common, and, unfortunately, most affected women undergo laparotomy for possible appendicitis. We present an interesting case of OVT presenting as ureteral obstruction in a postpartum woman who was in her early 20s. Knowledge of this entity and clinical suspicion for its occurrence, in a puerperal patient with fever and abdominal pain not responding to antibiotics, should guide clinicians to appropriate diagnosis and treatment, avoiding misdiagnosis, unnecessary laparotomy and potential complications.